Health and Healthcare Systems

Why helping cross-border commuters is key to fighting COVID-19

Healthcare workers react as people clap for them on National Nurse Day outside NYU Langone Health during the outbreak of the coronavirus disease (COVID-19) in the Manhattan borough of New York City, U.S., May 6, 2020. REUTERS/Andrew Kelly - RC2BJG9A82KZ

Helping nurses cross borders can create a better response to any global crisis. Image: REUTERS/Andrew Kelly

Sandra Caballero
Project Specialist, Autonomous and Urban Mobility, World Economic Forum
  • Thousands of essential healthcare workers cross the border between Canada and the U.S. every day.
  • A new initiative backed by a major healthcare employer and the World Economic Forum is investigating ways of providing these workers with a viable, reliable commute as a key part of creating a better response to the pandemic.
  • Lessons from this initiative are applicable broadly to employers who need lower-waged and essential workers to be able to safely return to work

Every day, thousands of essential healthcare workers cross the border between Canada and the United States to work in U.S. hospitals and help fight the COVID-19 pandemic. During these difficult times, Cross-border commuters often face specific challenges, such as disrupted or absent public transport networks, as well as the risk of border closures and tighter controls. But their struggle also holds broader lessons for how we can improve the daily journeys of all commuters, especially in lower-paid professions.

Commuting is generally thought of as a private matter, to be organized by the employee in their own time and usually, on their own budget. The employer expects them to show up in the right place at the right time, and the rest is up to them. The pandemic has shown that this attitude needs to change if we want our workforce to be resilient and productive - including our essential workers. They often face a disproportionate financial and logistical burden when it comes to transport.

In a report by the Surface Transportation Policy Project by Smart Growth America, researchers found that the poorest 20% of Americans spend 40.2% of their take-home pay on transportation (mostly for private vehicle expenses). Those who make $71,898 and more only spend 13.1%. In the nursing profession nationwide, entry level workers start at approximately $41,000. If healthcare workers are forced to travel by car for lack of other options, the cost of buying and maintaining that car alone will significantly chip away at their take-home pay.

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In border areas, commuting can be even more burdensome. The busiest border crossing between Canada and the USA lies between the cities of Windsor, Ontario and Detroit, Michigan. The two cities are divided by the Detroit River and are connected by a series of transnational bridges and tunnels, which hundreds of Canadian healthcare workers cross daily to provide essential care in Detroit-area hospitals. A survey of hospital staff in the Detroit area found that 10-20% of the workforce identified as Canadian and crossed the Detroit-Windsor border for every shift. 90% of those border-crossing workers depend on a private vehicle to travel to work.

Along with the expenses of vehicle ownership and maintenance, these workers also have to consider the additional burden of traffic congestion, especially in light of increased border restrictions. During the pandemic, transportation options have dwindled in part due to reduced public transit service, more costly shared mobility option and fear of infection in public transit. This problem disproportionately affects women, because they represent the majority of essential healthcare workers. In the Detroit-Windsor area, 80% of healthcare workers are women, which is broadly in line with the rest of the United States, where women make up 76% of the essential workers in health care.

As we face a potential second wave of the pandemic – and as many of us are still struggling with the first wave – it is time to think about what responsibilities come with depending on essential workers. One key element to consider is ease of transportation access, which remains a huge challenge in many areas of the United States. While large cities like New York offer a range of travel options including buses, trains, subways, taxis and bike shares, rural areas and border crossings are often mobility deserts. Indeed, rural areas around the world typically depend on private car ownership. The coronavirus outbreak has made this challenge even more obvious. Something as seemingly simple as reaching a COVID-19 test center can be difficult for people who don’t have a car and live far away from hospitals and other healthcare facilities.

Where Does Commuting Cost the Most?
Where Does Commuting Cost the Most? Image: Statista

Many aspects of cross-border commuting are still not fully understood. Travelling from Windsor to Detroit and back is in some ways like commuting between two neighbourhoods of the same cities, since the two are geographically close - as close as Brooklyn and Manhattan. But in other ways, it is shaped by the restrictions that come with international travel, such as passport controls and potential border closures.

This is why the World Economic Forum launched the Inclusivity Quotient project and developed a workstream on return to work focusing on solving the commuting gap for the backbone of the economy. The use case of cross-border commuters between Ontario and Michigan could start quantifying both the organizational and social benefits of a deliberate, proactive commuting strategy. As part of this initial pilot case study, IQ has partnered with the Henry Ford Health System, a nonprofit health case organization in Detroit, to begin working in partnership with the City of Windsor to conduct qualitative interviews and worker outreach to analyze and better understand cross border commutes of its own essential workers.

If employers and governments come together to offer a better commute, the result could transform the lives of countless essential workers - and those of the people who depend on their daily labour. This is just one example of many which the IQ project intends to highlight. The goal of IQ is to pinpoint strained commutes for essential workers and work with employers and government transit providers to brainstorm alternative transportation services that could help essential workers get to work with ease. These first case studies will later inform IQ’s work as it seeks to pilot additional transit partnerships to get all other workers back to their jobs.

The goal of IQ is to address commuting pain points with new mobility services and solutions that can help improve both the accessibility of frontline workers to their patients and their productivity once they reach their destination. Commuting solutions will look different from city to city and region to region and will ultimately leverage the power of a multi-modal transportation system whether it be through public transit, shared mobility, or safe micromobility.

As the world considers a return to work and school, employers need to give serious consideration to this type of effort. Ultimately, restarting the economy heavily depends on getting workers, particularly lower-waged and essential employees, to work. This is becoming an even more pressing issue as we enter the flu season, and will need the support of workers in healthcare, retail and childcare to get us through this challenging time. The pandemic has shown us that we are all in this together. If healthcare workers face a commuting gap, all of the economy will suffer - not to mention the risk this poses to the health of millions of people.

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